Confused about When to Start Getting A Screening Mammogram? Age 40 or 50?

Confused about when to start getting a mammogram? You are not alone. In the past year, there have been several conflicting reports of scientific studies recommending annual screening mammogram at age 40 or age 50, depending on which study you read. Furthermore, there is confusion about whether to get your screening mammogram every year or every two years. Why all the confusion and where is it coming from?

Not all organizations agree on mammogram guidelines. For instance, the U.S. Preventive Services Task Force (USPSTF) mammogram guidelines recommend women begin screening at age 50 and repeat the test every two years. The American Cancer Society and other organizations recommend screening begin at 40 and continue annually.

The USPSTF recommendation is valid under the argument that women between the ages of 40 – 50 years derive only a small benefit from annual screening mammograms. But, ask yourself if you were the one person to get that “small benefit” would it matter to you? While there is the risk of false positive exams and further workups that put patients through further testing, no one disagrees whether the trouble was worth it when breast cancer is detected early and can make the most difference between life and death. No one disputes that screening mammograms saves lives. The key is early screening. While the benefit may be small, the benefit outweighs the perceived risks.

Ultimately, Digital Mammography Specialists (DMS), along with the National Cancer Institute, The American Cancer Society, the American College of Obstetricians and Gynecologists, the American Medical Association, and the U.S. Preventive Services Task Force encourages all women to discuss the risks and benefits of getting a mammogram with their doctors. No one should make this decision for a woman; it should always be her choice when to start screening for breast cancer.

At DMS, our expert women’s imaging radiologists recommend annual mammograms starting at age 40. The Joint Statement from the American College of Radiology and Society of Breast Imaging clearly spells out the compelling reasons to get a screening mammogram every year beginning at age 40.

It is well known that mammography has reduced the breast cancer death rate in the United States by 30 percent since 1990 ─ hardly a small benefit.
Based on data on the performance of screening mammography as it is currently practiced in the United States, one invasive cancer is found for every 556 mammograms performed in women in their 40s.
Mammography only every other year in women 50-74 would miss 19 to 33 percent of cancers that could be detected by annual screening.
Starting at age 50 would sacrifice 33 years of life per 1,000 women screened that could have been saved had screening started at age 40.
Eighty-five percent of all abnormal mammograms require only additional images to clarify whether cancer may be present (or not). Only 2 percent of women who receive screening mammograms eventually require biopsy. The USPSTF data showed that the rate of biopsy is actually lower among younger women.
DMS supports screening beginning at age 40 because screening mammograms can detect breast abnormalities early in women in their 40s. Findings from a large study in Sweden of women in their 40s who underwent screening mammograms showed a decrease in breast cancer deaths by 29 percent.

But mammogram screening isn’t perfect. Another study concluded that despite more women being diagnosed with early breast cancer due to mammogram screening, the number of women diagnosed with advanced breast cancer hasn’t decreased. The study suggested that some women with early breast cancer were diagnosed with cancer that may never have affected their health.

Unfortunately doctors can’t distinguish dangerous breast cancers from those that are non-life-threatening, so annual mammograms remain the best option for detecting cancer early and reducing the risk of death from breast cancer.

DMS will continue to evaluate new data on mammography and breast cancer detection as information is made available. But at this time, until a validated method exists that can identify tumors that are slow growing and non-lethal from those that are aggressive, DMS physicians feel it is in the best interests of their patients to offer routine screening mammography. And while they further acknowledge that reducing the number of mammograms offered to women, along with follow-up testing, would save healthcare dollars, they do not believe that denying quality care is the way to do it.

If you’re concerned about screening mammograms, discuss your concerns with your doctor. Together you can decide what’s best for you based on your individual breast cancer risk.

Talk with your doctor about:

Your personal risk of breast cancer.
The benefits, risks and limitations of screening mammograms.
The role of breast self-exams in helping you become more familiar with your breasts, which may help you identify abnormalities or changes.
The role of a clinical breast exam, which is an examination of your breasts by your doctor and is offered annually at Digital Mammography Specialists.
About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.